Assessment of disease management of acute respiratory tract infection at community pharmacies through simulated visits in Pakistan

Abstract

The present study aimed to document the state of Acute Respiratory Infection (ARI) management at community pharmacies in Pakistan. A cross-sectional study was conducted at randomly selected 371 pharmacies in three cities of Pakistan. Simulated patient visits were performed to collect information on case management of ARI in terms of history taking and patient counseling at community pharmacies. The data was coded, entered and analyzed by using SPSS Version 16. Kruskal-Wallis test (p < 0.05) was performed to find out differences. The patients were mainly handled by salesman 97.3%, by pharmacist 2.2% and pharmacy assistants 0.5%. The mean dispensing time was 1.11 mins (S.D ± 5.61) with the range of 0.5-6 min. Of the 371 simulated patients who visited the pharmacies, 82.2% (n = 305) were given medicines in case of ARI while 7.3% (n = 27) were referred to the doctor. In case of ARI, 57.4% (n = 211) of the subjects were given antibiotics, 12.8% (n = 47) antihistamines and 29.7% (n = 109) NSAIDs at community pharmacies in the three cities. Therapy given by dispensers was compared with minimum standard of history taking and provision of advice. None of the regimens completely matched with the minimum standard of history taking and provision of advice. The mean cost of treatment in case of ARI was Rs 19.66 (± 10.13, median = 17). The disease management of ARI by community pharmacies in Pakistan is distressing. Sale of antibiotics without prescription is common practice. The overall process of history taking and medication counseling at community pharmacies either located in rural or urban setting and irrespective of the provider type and location of pharmacies, in the three cities is limited.